Haematology: spur cell haemolytic anaemia: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Haematology: spur cell haemolytic anaemia

Sample item

A 55-year-old man with alcoholic cirrhosis develops a haemolytic anaemia. His smear shows dense red cells with a few irregular, spiky projections of unequal length. What is the underlying abnormality of these red cells?

ADeficiency of a membrane skeleton protein such as spectrinBExcess membrane cholesterol relative to phospholipidCMechanical fragmentation by fibrin strandsDOxidative denaturation of haemoglobin

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Excess membrane cholesterol relative to phospholipid

In severe liver disease, abnormal lipoproteins load the red cell membrane with cholesterol. The stiff cells, called acanthocytes or spur cells, are remodelled in the spleen and destroyed early.

Option by option

A. Deficiency of a membrane skeleton protein such as spectrin
Spectrin or ankyrin defects cause spherocytes in hereditary spherocytosis, not spiky acanthocytes in liver disease.
B. Excess membrane cholesterol relative to phospholipid (correct)
Correct. Cholesterol enrichment of the membrane produces rigid spur cells that are cleared in the spleen.
C. Mechanical fragmentation by fibrin strands
Fibrin strands produce schistocytes in microangiopathic haemolysis, not spur cells.
D. Oxidative denaturation of haemoglobin
Oxidative damage produces Heinz bodies and bite cells, as in G6PD deficiency.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is B, Excess membrane cholesterol relative to phospholipid. In severe liver disease, abnormal lipoproteins load the red cell membrane with cholesterol.

Why is "Deficiency of a membrane skeleton protein such as spectrin" not the answer?

Spectrin or ankyrin defects cause spherocytes in hereditary spherocytosis, not spiky acanthocytes in liver disease.

Why is "Mechanical fragmentation by fibrin strands" not the answer?

Fibrin strands produce schistocytes in microangiopathic haemolysis, not spur cells.

Why is "Oxidative denaturation of haemoglobin" not the answer?

Oxidative damage produces Heinz bodies and bite cells, as in G6PD deficiency.

What concept does this question test?

It tests Haematology: spur cell haemolytic anaemia in Pathology. The stiff cells, called acanthocytes or spur cells, are remodelled in the spleen and destroyed early.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Haematology: spur cell haemolytic anaemia?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.